Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If your Compulsory Third Party (CTP) claim has been denied by an insurer, you need to act quickly to protect your rights. Under NSW law, injured road users on the Central Coast have specific steps to take when a claim is rejected. This article explains the legal framework, practical actions, and time limits to consider when dealing with a denied CTP claim.
Understanding CTP Claim Denials in NSW
CTP claims are governed by the Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). Insurers may deny claims for various reasons, such as disputes over fault, incorrect claim forms, or failure to meet eligibility criteria. It is crucial to understand that a denial does not automatically mean your claim is invalid, it means further action is required.
Immediate Steps After a Claim Denial
- Review the Denial Letter: Insurers must provide a written explanation for rejecting your claim. Carefully read the letter to identify the reason for the denial. Common issues include incorrect details about the accident, failure to meet treatment thresholds, or disputes over fault.
- Contact SIRA: SIRA oversees the CTP scheme and can provide guidance on next steps. You can reach them directly or through your local NSW government office. They can help clarify whether your claim meets the legal criteria for benefits.
- Gather Evidence: Collect all relevant documents, including medical records, accident reports, witness statements, and photographs. These will support your case if you need to dispute the denial.
Time Limits and Dispute Options
NSW law imposes strict time limits for responding to denied claims. For example, if your claim is denied after 52 weeks, certain benefits may no longer be available under the Motor Accident Injuries Act 2017. If the denial relates to a threshold injury, you may need to seek legal advice to challenge the decision.
When to Seek Legal Advice
If the insurer’s denial is based on a dispute over fault, or if you believe the decision is incorrect, you may need to consult a solicitor. Legal advice is particularly important if the claim involves complex issues like contributory fault or long-term injuries.
Example Scenario
Consider a cyclist on the Central Coast who is denied a claim because the insurer disputes the severity of their soft tissue injury. Under the Motor Accident Guidelines, the cyclist must demonstrate neurological signs or radiculopathy to qualify for certain benefits. If the injury does not meet these criteria, the insurer may correctly deny the claim, but the injured person may still be eligible for other support.
Next Steps
CTP claims depend on the specific facts of your case, including the date of the accident, the nature of your injuries, and the insurer’s reasoning. To ensure you take the right actions, complete the quick, no obligation enquiry form to request contact about your circumstances.